A day in the life of a mental health technician

Adam Bonezzi wants to change people’s perceptions about what he does as a mental health technician on Akron Children’s Hospital’s inpatient psychiatric unit.

“It’s nothing like you see in movies where patients are heavily medicated, tied to beds and placed in padded rooms,” he said. “We get sad, angry, abused and depressed kids, but it’s rare that we get one who’s completely out of control.”

Today the 14-bed unit only has 1 open bed.

“Kids are admitted to this unit for 1 of 4 reasons,” said Bonezzi. “They are either suffering from psychosis, which basically means they are out of touch with reality, they are at high risk for either harming themselves or others, or they need help with medication management.”

Within 24 hours of admission, every child and teen must undergo a physical exam to rule out undiagnosed medical issues.

Bonezzi, who has a background in psychology and criminal justice, knew from an early age that he wanted to work in a field that would make a difference in people’s lives.

“I was bullied as a child and I have a passion for helping kids find their voice,” he said. “I chose to work with pediatric patients because, unlike adults, there aren’t a lot of behaviors you can’t undo.”

His day begins at 7 a.m. in the report room on the psychiatric unit, where he reviews run sheets, learns from night staff how each patient behaved on the prior shift, and chooses his assignment for the day.

“We have a lot of autonomy in this job and get to pick which patient we want to work with on any given day,” he said. “That could mean being responsible for 2 or more kids or taking a one-on-one assignment with a higher-risk child.”

Once assigned to a patient, Bonezzi can’t leave his patient’s side without arranging for coverage from another tech or nurse. “A typical schedule includes breakfast, followed by 45 minutes of physical activity, a goal-setting exercise, group sessions and school.

One of Bonezzi’s first tasks each day is to help the kids set their daily goals.

“We try to focus on goals that are measurable, like tactics for managing anger or impulsiveness,” he said.

Patients on the unit range in age from 5-17. However, school-age kids and adolescents are kept separate. They go to school and group sessions with kids their own age. Younger kids attend school for 2 hours and older kids for 1 hour daily. A teacher, provided by the Akron Public Schools, oversees class and homework assigned by the patients’ home schools.

“On the weekends kids watch an age-appropriate therapeutic movie like The Blind Side or Remember the Titans that showcase themes of young people overcoming challenges,” he said.

Bonezzi references a thick binder of lesson plans on anger, self-esteem, communication, stress and safety planning when he runs groups.

“I need to be creative and quick on my feet to keep their attention. Group therapy can be difficult for kids,” Bonezzi said. “Some patients get really nervous or a group session can sometimes trigger something bad or painful. In those instances, I may let my patient sit out the following group so I can have some one-on-one time to address what he’s feeling.”

Two focus rooms are available for techs to take kids who may need a more isolated environment to de-escalate their anger or inappropriate behavior.

The unit keeps strict visiting hours. Only parents, legal guardians and grandparents may visit from 5-7 p.m. If he’s not on a one-on-one assignment, Bonezzi sometimes helps with patient admissions, which usually occur between 3-7 p.m. and can take up to an hour.

“Patient admissions are very detail oriented and time consuming,” he said. “It’s a chance for the parent or child to unload and tell me everything that has been going on. One of the greatest skills I possess as a tech is being an active listener.”

Children admitted to the psychiatric unit must first be assessed in Akron Children’s Behavioral Health ER. In some cases, they need medical stabilization for a few days before moving to the unit.

Kids who have overdosed on drugs or alcohol – either intentionally or unintentionally — are automatically admitted to a medical floor before coming to the unit.

After visiting hours, Bonezzi provides snacks and goes over goal review sheets. “We talk about how they did and what they may have been able to do better.”

A typical length of stay is 4 days – in most cases long enough to stabilize patients and give them tools to help keep them safe at home.

A “level system” allows patients the chance to earn privileges like wearing their own street clothes, ordering off the regular hospital menu, and a 10-minute phone call to the person of their choice.

Before discharge, every child must have an outpatient care plan.

By the end of a patient’s stay, Bonezzi often sees a new person emerge.

“It’s really interesting to watch the behavioral changes and the progress these kids make in a few short days. For some it’s like coming out of a mental fog, and you feel like you’re seeing their true personalities emerge for the first time.”